tbuckley/cabot-search huggingface dataset:
Abstract 11152: Complications Associated With Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions in the United States: 2012-2022
Authors: Ammar A Hasnie, Vibhu Parcha, RIEM HAWI, Michael L Trump, Naman Shetty, Mustafa I Ahmed, Oscar J Booker, Pankaj Arora, Garima Arora
Journal: Circulation (2022)

Introduction: Transesophageal echocardiograms (TEEs) performed during structural cardiac interventions may have higher complications than those performed in the non-operative setting. However, there is limited data on complications associated with TEE in these procedures. The objective of this study was to evaluate the prevalence of major complications among these patients in the United States (US). Methods: A retrospective cohort study was conducted using an electronic health record database from large academic medical centers across the US for patients undergoing TEE during structural interventions from January 2012 to January 2022. Using the American Society of Echocardiography endorsed ICD-10 codes, patients undergoing TEE during a structural cardiac intervention, including transaortic, mitral or tricuspid valve repair, left atrial appendage occlusion, and paravalvular leak replacement were identified. The primary outcome was major complications within 72 hours of the procedure (composite of bleeding, esophageal and upper respiratory tract injury). Results: A total of 9,482 adult patients undergoing TEE for transcatheter structural cardiac interventions were identified. The median age was 71 years (IQR: 61 - 80 years), including 43% females and 19% non-white individuals. Of those, 7,158 (75%) of patients were on anticoagulation, and 6,272 (66%) were on antiplatelet therapy. In the study cohort, 246 (2.6%) patients had a major complication. Complication rates were higher in patients on anticoagulation or antiplatelet therapy compared to those who were not (2.9% vs. 0.84%, p&lt;0.001, OR: 3.57 [95% CI: 1.89- 6.74]). Patients aged ≥65 had higher rates of major complications compared with those &lt;65 (2.95% vs. 1.16%, p&lt;0.001). Complication rates were similar among males and females (2.7% vs 2.5%, p=0.50). Conclusions: Nearly 2.6% of patients undergoing TEE during transcatheter structural cardiac interventions have a major complication. Major complications are relatively more common among older patients and those on anticoagulant and antiplatelet therapy. With a shift of poor surgical candidates to less invasive procedures, the future of TEE-guided procedures relies on a heart team approach and a comprehensive risk discussion.
Abstract 11364: Risks Factors for Malignant Arrhythmias and Sudden Cardiac Death in Patients With Mitral Valve Prolapse: A Systematic Review and Meta-Analysis
Authors: Juthipong Benjanuwattra, Jakrin Kewcharoen, Natnicha Leelaviwat, Poemlarp Mekraksakit, Gaspar Del Rio-Pertuz, Mahmoud Abdelnabi, Adivitch Sripusanapan, Angkawipa Trongtorsak, Sittinun Thangjui, Leenhapong Navaravong
Journal: Circulation (2022)

Introduction: Mitral valve prolapse (MVP) is a common valvular disorder affecting approximately 3% of the population. Several risk factors in patients with MVP for malignant arrythmias, including ventricular tachycardia (VT), fibrillation (VF), and sudden cardiac death (SCD), have been proposed. We performed systematic review and meta-analysis to evaluate risk factors for malignant arrhythmias in patients with MVP. Methods: We comprehensively searched the databases of MEDLINE from inception to May 2022. Included studies were published cohorts comparing patients with MVP and malignant arrhythmias or SCD versus MVP without those events. Data from each study were combined using the random-effects model. Pooled odd ratios (OR) and 95% confidence intervals (CI) were calculated. Results: Five studies from 1985 to 2021 were included involving 769 patients with MVP [100 patients with SCD, VF, VT, and/or implantable cardioverter defibrillator (ICD) shocks]. We found that T-wave inversion (pooled OR=3.14, 95%CI: 2.18-4.5, p&lt;0.001), bileaflet (pooled OR=2.37, 95%CI: 1.39-4.04, p=0.002), late gadolinium enhancement (pooled OR=41.8, 95%CI: 10.7-163, p&lt;0.001), mitral annular disjunction (pooled OR=4.8, 95%CI: 2.7-8.4, p&lt;0.001), redundant leaflets (pooled OR=4.6, 95%CI: 1.02-21.0, p=0.048), and history of syncope (pooled OR=2, 95%CI: 1.002-4.02, p=0.049), were associated with malignant arrythmias and SCD. However, female sex (pooled OR=0.83, 95%CI: 0.26 - 2.65, p=0.748) and moderate-to-severe mitral regurgitation (pooled OR=0.85, 95%CI:0.15-4.91, p=0.853) did not increase the risk. Conclusion: T-wave inversion, mitral annular disjunction, late gadolinium enhancement, history of syncope, redundant leaflets and bileaflet prolapse are associated with an increased risk of malignant arrhythmias and SCD in patients with MVP. Further studies are needed to evaluate the role of electrophysiologic study and ICD in this high-risk population.
Abstract 11232: Coronary Artery Bypass Graft Surgery Shows Improved Restricted Mean Survival Time and Time Lost Compared to Medical Therapy in Patients With Left Ventricular Dysfunction: From the STICH Trial
Authors: Samuel W Reinhardt, Haocheng Huang, Helen Parise, Tariq Ahmad, Eric J Velazquez, Kamil F Faridi
Journal: Circulation (2022)

Background: Restricted mean survival time (RMST) and restricted mean time lost (RMTL) are alternative clinical trial outcome measures that can be used to quantify treatment effects. In this study we evaluated RMST and RMTL in the STICH trial to quantify long-term treatment effects of coronary artery bypass graft surgery (CABG) vs. medical therapy in patients with coronary artery disease (CAD) and depressed left ventricular ejection fraction (LVEF). Methods: RMST was calculated as the average event-free survival up to follow-up at 10 years. RMST was calculated separately using i) the trial follow-up time and ii) age instead of time with estimation of age-specific events rates. Delta RMST was determined for CABG vs. medical therapy, with delta RMST &gt;0 favoring CABG. The RMTL ratio was calculated by dividing the RMTL of the CABG group by the RMTL of the medical therapy group, with a ratio &lt;1 favoring CABG. Analysis was performed for the primary and secondary outcomes for the entire cohort and prespecified subgroups. Results: For the primary outcome of all-cause mortality, RMST for the CABG group was 2714 days vs. 2501 days for the medical therapy group (delta RMST = 213 days [95% CI 21.63, 404.63]; p=0.029). The RMTL ratio for all-cause mortality was 0.90 (95% CI 0.82, 0.99; p = 0.030). For the secondary outcomes of death from cardiovascular (CV) causes, all-cause mortality or CV hospitalization, and all-cause mortality or revascularization, delta RMST and the RMTL ratio favored CABG over medical therapy (Figure). In subgroup analyses of all-cause death, delta RMST and RMTL ratio favored CABG in patients under 60 years old, racial/ethnic minorities, and those with 3-vessel disease. Conclusion: In 10-year follow up in the STICH trial, RMST and RMTL both favored CABG compared to medical therapy for all-cause mortality and other cardiovascular endpoints in patients with CAD and low LVEF. These findings can be used to help quantify the potential benefits of CABG in this population.
Abstract 11728: Predictors of Secondary Pulmonary Hypertension-Related Hospitalizations and Subsequent Mortality in Adults With Obstructive Sleep Apnea
Authors: Avilash Mondal, Sai Gautham Kanagala, Adil S Mohammed, Nishanth Katukuri, Priyatham Gurram, Mariam Ashfaque, Amara Sofia, Humaira Kauser, Satya Sai Venkata Lakshmi Arepalli, Qudsia Sayyeda, Rupak Desai
Journal: Circulation (2022)

Background: Secondary pulmonary hypertension (SPH) is a predictor of poor outcomes in obstructive sleep apnea (OSA) patients. In this study, we examined sex/racial disparities, predictors and inpatient mortality in SPH-related hospitalizations among OSA patients. Methods: We used the National Inpatient Sample (2019) and ICD-10 codes to identify OSA-related hospitalizations with SPH. The burden of SPH and disparities by sex/race were assessed. We also compared the odds and predictors of in-hospital mortality in OSA patients with vs. without SPH. Results: Of total adult OSA hospitalizations (n=2317136, median age 66[56-74] years, males: 57.2%), 9.4% (218795/2317136) had SPH. Females vs Males (11.3% vs. 8.1%) and Blacks vs. other race groups (13.5%) with OSA had a higher prevalence of SPH [Fig. 1] . The SPH cohort often consisted of females (51 vs 41.9%), blacks (20.9 vs 14.0%), patients from lowest income quartile (29.7 vs 27.6%), Medicare insured (73.4 vs 60.6%), and non-elective admissions (89.2 vs 74.4%) vs. non-SPH cohort. SPH cohort also had a higher burden of complicated HTN (52.9 vs 36.3%), DM with complications (42.7 vs 32.4%), hyperlipidemia (59.4 vs 57.6%), COPD (52.5 vs 36.9%), history of prior MI (11.4 vs 9.6%) and venous thromboembolism (10.4 vs 8.4%). However, in-hospital mortality was more likely to be in males (OR 1.12 95%CI 1.00-1.25, p=0.048) vs Females, and OSA patients with metastatic cancer (OR 2.73 95%CI 2.04-3.65), solid non-metastatic tumors (OR 1.65 95%CI 1.26-2.15) (p&lt;0.001). Our analysis also showed black ethnicity, hyperlipidemia, obesity, tobacco use, and history of venous thromboembolism and TIA were protective against inpatient mortality in SPH-OSA patients. Conclusions: The prevalence of SPH with OSA was greater in females and blacks, whereas males and whites had higher subsequent inpatient mortality. More prospective studies are needed to understand the role of co-morbidities on survival outcomes.
Abstract 11984: A Novel Pathogenic <i>Gata6</i> Variant Identified in a Family With Persistent Truncus Arteriosus, Childhood-Onset Diabetes Mellitus and Spontaneous Intestinal Perforation
Authors: Jun Yasuhara, Sathiyanarayanan Manivannan, Uddalak Majumdar, David Gordon, Katherine Myers, Gloria Zender, Kim L McBride, Peter White, Vidu Garg
Journal: Circulation (2022)

GATA6 is a member of the GATA family of transcription factors, among which GATA4, 5 and 6 are known to play critical roles during heart development. Pathogenic variants in GATA6 have been primarily associated with congenital heart disease (CHD) and pancreatic agenesis in humans. Although the phenotypic spectrum associated with pathologic variation in GATA6 has expanded to include developmental delay along with congenital malformations affecting the biliary system and diaphragm, the full disease spectrum of GATA6 pathogenic variation and genotype-phenotype correlations are unclear. Here, we report a family where the father had persistent truncus arteriosus (PTA) and three children had CHD, 2 with PTA and 1 with an atrial septal defect. Notably, the father had childhood-onset diabetes mellitus and one child had spontaneous intestinal perforation (SIP). Using exome sequencing, we identified a novel, heterozygous missense variant in GATA6 (c.1403G&gt;A; p.Cys468Tyr) in affected members. This variant is absent from the gnomAD and ExAC databases and causes a missense change predicted to be damaging by all in silico bioinformatic tools. Sanger sequencing confirmed the exome sequencing results and segregation of this variant. GATA6 p.Cys468Tyr variant affects the highly conserved zinc-finger domain of GATA6 and impedes its ability to bind DNA. Using wild-type and mutant GATA6 constructs driving atrial natriuretic peptide promoter reporter, in vitro luciferase assays showed that p.Cys468Tyr mutant protein exhibited significantly decreased luciferase transcriptional activity. Furthermore, immunofluorescence revealed that p.Cys468Tyr mutant demonstrated an impaired localization pattern in the nucleus and induced protein aggregation. Our findings expand the variant and phenotypic spectrum for GATA6. Our study highlights that GATA6 variants can cause not only cardiac and pancreatic malformations but also gastrointestinal abnormalities, including neonatal SIP. Further investigation is needed to define the mechanisms underlying the full phenotypic spectrum associated with pathogenic variation in GATA6 .
Abstract 12730: Comparisons of Health Outcomes Between Baby Boomers and Silent Generation Among Older Adults With Heart Failure
Authors: Jiarong Wu, Abigail Latimer, Chin-Yen Lin, Debra K Moser
Journal: Circulation (2022)

Background: Heart failure (HF) is a clinical syndrome of aging. Many studies compare older (≥65 years) and younger (&lt; 65 years) participants’ HF experiences as younger patients’ HF etiology and psychobehavioral factors are distinct from older patients. Yet, best practice geriatric HF management necessitates understanding of the differences present among older generations. Objective: To compare health outcomes (cardiac event-free survival and quality of life [QoL]) in older adults with HF by generational cohort including baby boomers and silent generation. Method: This 2-year longitudinal study of 497 patients with HF (male 61%, age 65±9 years, NYHA III/IV: 34%) included cardiac event data (i.e., HF readmission and cardiac death) collected from patient interview, hospital database and death certificate. QoL was measured using the Minnesota Living with Heart Failure. We collected demographic (e.g., gender, race), clinical (e.g., comorbidities), and psychobehavioral (e.g., depressive symptoms, anxiety, HF knowledge, self-care) factors as covariates. We conducted Chi-squares, t-tests, linear and Cox regression for data analysis. Results: Two fifths of the participants (39.63%) were baby boomers. Baby boomers had more depressive symptoms, higher levels of anxiety, lower levels of B-type natriuretic peptide, and higher number living in the same house than those in the silent generation (all P &lt;.05). Lower percentages of baby boomers were Whites and unemployed compared to the silent generation cohort ( P &lt;.05). There were no differences in other covariates between the two cohorts. Baby boomers had significantly worse QoL than patients in the silent generation ( P &lt;.001). Before and after adjusting for covariates, generation cohort was a significant predictor of cardiac event-free survival (HR=1.46-1.47, both P &lt;.05). Conclusion: Baby boomers with HF had better cardiac event-free survival, but more depressive symptoms, higher levels of anxiety, and worse QoL compared to older adults in the silent generation. In the US, baby boomers are the largest generational cohort in 2022 and are approaching their late 50s and mid-70s. As this group continues to age with increasing rates of HF, practice and research will benefit from continued focus on their needs.
Abstract 11494: Electrophysiological Effects of Sympathoexcitation are Mitigated by Blockade of Neuropeptide Y Y2 Receptors on Cardiac Parasympathetic Nerve Terminals
Authors: Valerie Y Van Weperen, Jonathan D Hoang, Neil R Jani, Zulfiqar A Lokhandwala, Maryam Emamimeybodi, Christopher A Chan, Mohammed A Swid, Marmar Vaseghi
Journal: Circulation (2022)

Introduction: Sympathetic activation releases both norepinephrine and co-transmitter neuropeptide Y (NPY). NPY can predispose to ventricular arrhythmias via receptors on cardiomyocytes. Ex vivo studies suggest that NPY may concomitantly reduce vagal tone via activation of NPY Y2 receptors (Y2R) on parasympathetic nerves, reducing acetylcholine release and further augmenting pro-arrhythmic sympathetic effects. We evaluated if parasympathetic Y2R blockade can prevent NPY-induced vagal inhibition, restore autonomic balance and stabilize cardiac electrophysiology. Methods: Yorkshire pigs (n = 12) underwent bilateral stellate ganglia stimulation (BSGS; 10 Hz, 4 ms) for 45 secs, before and after administration of selective Y2R antagonist BIIE0246 (BIIE; 32 nmol/kg bolus + 2 nmol/kg/min infusion). Hemodynamic and electrophysiological recordings were obtained with a left ventricular pressure (LVP) catheter, surface electrogram and a 56-electrode sock placed over the ventricles to measure activation recovery intervals (ARI), a surrogate of local action potential duration, from unipolar electrograms. Heart rate variability parameters, including low to high frequency ratio (LF/HF), were analyzed pre- and post-BIIE. Results: BSGS significantly increased heart rate (HR) and LVP, and shortened ventricular ARIs. BIIE significantly reduced both the rate of change and the maximal changes in HR and ARIs during BSGS. As anticipated, BSGS significantly increased LF/HF ratio, but this effect was abolished after BIIE. BIIE did not affect BSGS related increases in LVP. Conclusions: Cardiac effects of sympathetic activation are mediated, at least in part, by suppression of vagal tone through binding of NPY to parasympathetic Y2Rs. Blockade of this receptor partially counters pro-arrhythmic electrophysiological effects of BSGS and suggests a possible novel adjuvant role for Y2R blockade as a therapy for reducing consequences of sympatho-excitation.
Abstract 11119: Racial and Ethnic Disparities in Preoperative Characteristics and Outcomes Following Mitral and Tricuspid Valve Surgery
Authors: Nolan M Winicki, Isabella S Florissi, Salman Zaheer, Sari D Holmes, Diane E Alejo, Clifford E Fonner, James S Gammie
Journal: Circulation (2022)

Introduction: Prior investigations assessing the impact of race and ethnicity on outcomes after mitral valve surgery have reported conflicting findings. The aim of this analysis was to examine the association of race with characteristics and outcomes for patients undergoing mitral and tricuspid valve (MV; TV) surgery using a representative statewide database. Methods: We performed retrospective analyses on 5,929 patients (2,707 female, median age 63 yrs) who underwent MV ( n =4,490, 76%), TV ( n =473, 8%), or both MV and TV ( n =966, 16%) surgery in a statewide collaborative of 10 centers from 2012-2020. The influence of race/ethnicity on preoperative characteristics, MV and TV repair rates, and postoperative outcomes was assessed for White ( n =4,208, 71%), Black ( n =1,261, 21%), Hispanic ( n =140, 2%), Asian ( n =169, 3%), and mixed/other race ( n =151, 3%) patients. Results: Black patients, compared to White patients, had a higher Society of Thoracic Surgeons predicted risk of morbidity or mortality (24.5% vs 13.1% P &lt;0.001) with a higher incidence of previous valve operations, myocardial infarction, stroke, hypertension, diabetes, and chronic lung disease. Compared to White patients, Black and Hispanic patients were less likely to undergo an elective procedure (White 71%, Black 55%, Hispanic 58%, P &lt;0.001). Degenerative MV disease was more prevalent in White patients (White 62%, Black 41%, Hispanic 43%, Asian 51%, mixed/other 45%, all P &lt;0.05) while rheumatic disease was more prevalent in non-White patients (Asian 28%, Hispanic 26%, mixed/other 25%, Black 17%, White 10%, all P &lt;0.05). Repair for degenerative MV disease was more prevalent in White vs Black patients (84% vs 74%, P &lt;0.001), but after multivariable adjustment race was no longer associated with MV repair ( P =0.073). In multivariable analyses, adverse postoperative outcome incidences were not different by race groups, including mortality. Conclusions: Patient race/ethnicity affects the burden of comorbidities at the time of presentation for operation and MV disease etiology. Strategies to improve early detection and referral for surgery and to decrease rates of rheumatic disease for racial and ethnic minority patients with MV and TV disease may enhance outcomes.
Abstract 11812: Effects of Statins on Epicardial Adipose Tissue in Coronary Artery Disease
Authors: Nur Amirah Syahindah Raffiee, Hsin Tung Yap, Yan Ting Loong, Arun Elankovan, Xiaomeng Wang, Shuang Leng, Jaryl Chen Koon Ng, Weimin Huang, Hwee Kuan Lee, Mark Chan, Lynette Teo, Min Sen Yew, Swee Yaw Tan, Liang Zhong, Lohendran Baskaran
Journal: Circulation (2022)

Introduction: Coronary artery disease (CAD) is linked to many modifiable cardiovascular risk factors (CVRF) like smoking, diabetes, hypertension, hyperlipidaemia and obesity. High Epicardial Adipose Tissue (EAT) Hounsfield Unit (HU) attenuation using Non-contrast Computed Tomography (NCCT) is associated with more inflammation. Statin is believed to stabilise coronary plaque and reduce inflammation. However, its effects on EAT volume (EATv) and EAT HU is unknown. In this study, we quantified EAT and compared total EATv, mean EAT HU and percentage of EATv within -60 to -30 HU and -70 to -30 HU between group with statin treatment (S) and group with no statin (NS) treatment in an Asian cohort. Methods: 343 patients presenting with stable chest pain and no previous known CAD were recruited. Pericardium was segmented from NCCT. EAT volume (in cm3) and mean attenuation (in HU) were quantified with -190 to -30 HU threshold within pericardium. In subanalysis, percentage of EAT volume in the HU limits of -60 to -30 and of -70 to -30 were calculated. EAT parameters were compared between S group and NS group, adjusting for hypertension, hyperlipidemia, diabetes and smoking history. Results: The cohort comprised 343 patients (M:F 65%:35%; mean age 59±10 years old), with prevalence of hypertension (54%), hyperlipidemia (74%) and diabetes (21%), and smoking (14%). Median coronary artery calcium score was 96.0 (21.0-324.0). Mean EAT HU was significantly lower in S than NS group (p=0.024). Percentage of total EAT within the -60 to -30 HU range was also significantly lower among S than NS (p = 0.026). This was also observed using -70 to -30 HU range (p = 0.025). EATv was not significantly different between S and NS groups (p = 0.159). Conclusions: Patients on statin treatment showed lower EAT attenuation, with lower EAT HU and percentage of EAT volume within the HU ranges of -60 to -30 and -70 to -30. This suggests that statin use is associated with reduced EAT inflammation independent of EAT volume.
Abstract 12073: Electrical Storm Triggered by Car T-cell Therapy
Authors: Ari J Bennett, Thomas P Koshy, James D Daniels, Farrukh T Awan, Vlad G Zaha, Srilakshmi Vallabhaneni
Journal: Circulation (2022)

Background: Neither sustained VT nor electrical storm have been described in the setting of chimeric antigen receptor (CAR) T-cell therapy. Case: A 67-year-old man with a history of HFrEF (EF 47%), asymptomatic CAD with PCI to the RCA 18 years prior, hypertension, and metastatic synovial sarcoma status post anthracycline-based chemotherapy presented to our institution for CAR T-cell therapy. On treatment day 2, he developed high fevers unresponsive to acetaminophen, 3 doses of tocilizumab, IV dexamethasone, anakinra, and empiric broad spectrum antibiotics; his CRP at the time was 140.9 mg/L, consistent with severe cytokine release syndrome. On day 6, he felt new palpitations associated with frequent ten-second runs of NSVT. Notable labs included a flat hs-cTnI at 8 ng/L, NT-proBNP of 1,315 pg/mL, and Mg of 1.9 mg/dL. After 6 hours, the ectopy progressed to sustained, symptomatic monomorphic VT that initially responded to a 150 mg amiodarone bolus and drip, 25 mg of metoprolol tartrate q6h, and Mg repletion. Overnight, however, the patient developed multiple recurrences of the sustained VT. Amiodarone reloading and lidocaine bolus and drip successfully eliminated the ventricular ectopy. A subsequent cardiac MRI showed global hypokinesis with basal inferolateral akinesis; an LVEF of 38%; prolonged T1 and T2 parameters; and inferoseptal, inferior, and inferolateral delayed enhancement consistent with ischemic cardiomyopathy. An EP study elicited multiple sustained, hemodynamically unstable monomorphic VTs with changing QRS morphologies by programmed stimulation, so a dual chamber ICD was implanted. Finally, a coronary CTA revealed CTO of a mid RCA stent. The patient was discharged on amiodarone and metoprolol—as well as guideline-directed medical therapy for his CAD and HFrEF—without any VT recurrence on follow-up. Conclusion: Electrical storm is a previously undescribed complication of CAR T-cell therapy. The presumed mechanism for VT in this case was ischemic scar-mediated reentry triggered by cytokine release syndrome. This case highlights a potential role for myocardial tissue characterization with multiparametric cardiac MRI, in addition to ischemic evaluation, in high-risk patients prior to CAR T-cell therapy.